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There is an ongoing trend toward more frequent and multiple crises. While there is a clear need for behaviors to become more sustainable to address the climate crisis, how to achieve this against the backdrop of other crises is unknown. Using a sample of 18,805 participants from the UK, we performed a survey experiment to investigate if communication messages provide a useful tool in nudging intentions toward improved sustainability in the context of the COVID-19 pandemic. We found that, despite the ongoing COVID-19 crisis, media messaging resulted in increases in sustainability-related intentions for all our communication messaging conditions. Specifically, after our communication was presented, (i) almost 80% of people who were not currently recycling their surgical masks reported their intention to do so; there was a > 70% increase in both (ii) the number of people likely to pick up face mask litter and (iii) the number of people willing to disinfect and reuse their filtering facepiece (FFP) masks 4–6 times, while (iv) there was an increase by 165% in those who would wash cloth masks at 60 °C. Our results highlight that communication messaging can play a useful role in minimizing the trade-offs between multiple crises, as well as maximizing any synergies. To support this, decision-makers and practitioners should encourage the delivery of sustainability advice via multiple sources and across different types of media, while taking steps to address potential misinformation. [ABSTRACT FROM AUTHOR]

Background An estimated one in five Australians aged 60 years and older have sarcopenia, marked by progressive and accelerated loss in muscle mass, strength and function. Sarcopenia is associated with considerable healthcare costs and a myriad of adverse health outcomes, including increased risk of death. Despite its clinical importance, muscle health is often overlooked in routine clinical practice, hindering diagnosis and treatment. Objective In July 2023, eight representatives from Australia's primary care and research communities convened to discuss barriers to sarcopenia screening, assessment and management within routine clinical practice. Solutions were proposed to improve the implementation of muscle health assessment and management in general practice. This article summarises the key discussions and outcomes from this meeting. Discussion Strategies to improve the implementation of muscle health assessment and management in general practice include (1) improving public awareness; (2) professional education; (3) provision of tools and resources; (4) advocacy and policy; and (5) increasing collaborative efforts between healthcare professionals, professional societies, universities, electronic medical record software vendors and the government. [ABSTRACT FROM AUTHOR]

Background: Telemedicine allows delivery of healthcare to occur between parties that are not in the same location. As telemedicine users are not co-present, effective communication methods are crucial to the delivery and reception of information. The aim of this study was to explore perspectives of general practitioners (GPs) and patients on the interactional components of telemedicine consultations. Methods: Semi-structured qualitative interviews were held with telemedicine users; 15 GPs and nine patients self-selected from a larger telemedicine study. Participants were asked about their preparation for telemedicine consultations, conducting telemedicine consultations and post-consultation activities. Deidentified transcripts from the interviews were analysed thematically. Results: GPs and patients discussed factors they used to decide whether a consultation would be best conducted by telemedicine or in-person; the condition to be discussed, the existing doctor-patient relationship and whether physical examination was required. Participants also described how they prepared for their telemedicine consultations, gathering relevant documents, and reading previous notes. Participants described strategies they employed to optimise the telemedicine interaction; improving conversational flow and building rapport, as well as difficulties they experienced when trying to provide and receive care via telemedicine. Conclusions: Patient factors including health literacy and familiarity with technology affect the transfer of information shared during telemedicine consultations and consideration of these factors when choosing patients for telemedicine is required. Many GPs and patients have innate communication skills to effectively deliver and receive care through telemedicine. However, they may not be aware of these subconscious techniques to use to optimise telemedicine consultations. Communication training could be delivered to increase conversational flow, build rapport, and establish safety netting. [ABSTRACT FROM AUTHOR]

Background: The unprecedented increase in telehealth use due to COVID-19 has changed general practitioners' (GP) and patients' engagement in healthcare. There is limited specific advice for effective communication when using telehealth. Examining telehealth use in practice in conjunction with perspectives on telehealth as they relate to communication allows opportunities to produce evidence-based guidance for optimal use of telehealth, while also offering practitioners the opportunity to reflect on elements of their communicative practice common to both styles of consultation. The objective of this research was to develop evidence-based resources to support effective, person-centred communication when GPs and patients use telehealth. This included examination of interactional practices of recorded telehealth consultations, exploration of GP and patient perspectives relating to telehealth, and identifying priorities for guidance informed by these analyses as well as participant co-design. Methods: This study involved recording telehealth consultations (n = 42), conducting patient surveys (n = 153), and interviewing patients (n = 9) and GPs (n = 15). These were examined using interaction analytic methods, quantitative analysis, and thematic analyses, to create a robust, integrated picture of telehealth practice and perspectives. The process of research translation involved a co-design approach, engaging with providers, patients, and policy makers to facilitate development of evidence-based principles that focus on supporting effective communication when using telehealth. Results: Three key themes relating to communication in telehealth were identified across the different analyses. These were relationship building, conversational flow, and safety netting. The draft best practice principles drawn from these themes were modified based on co-design feedback into five Best Practice Principles for Communication between GPs and Patients using Telehealth. Conclusions: Effective communication is supported through relationship building and attention to conversational flow in telehealth consultations, which in turn allows for safety netting to occur. In telehealth, GPs and patients recognise that not being co-present changes the consultation and use both intuitive and strategic interactional adjustments to support their exchange. The mixed-method examination of experiences through both a detailed analysis of telehealth consultations in practice and comparative exploration of GP and patient perspectives enabled the identification of principles that can support effective communication when using telehealth. Co-design helped ensure these principles are ready for implementation into practice. [ABSTRACT FROM AUTHOR]

Background: Many colorectal cancer (CRC) survivors experience ongoing sequelae from their cancer treatment. Limited evidence exists regarding how CRC survivors and general practitioners (GPs) manage these sequelae in the community. This study aimed to explore the experiences and perspectives of CRC survivors and GPs on current approaches to monitoring and managing sequelae of CRC treatment. Methods: We conducted a mixed-methods study using cross-sectional national surveys and qualitative interviews with CRC survivors and GPs to explore: (1) treatment sequelae experienced by CRC survivors, (2) how these were monitored and managed by general practitioners, and (3) suggestions to improve ongoing management of the treatment sequelae. Survey responses were reported descriptively. Qualitative data were thematically analysed using an interpretive descriptive approach. Results: Seventy participants completed surveys: 51 CRC survivors and 19 GPs, and four interviews were conducted with GPs. CRC survivors experienced a range of treatment sequelae, but often did not discuss these with their GPs (experienced vs discussed: 86% vs 47% for fatigue/lack of energy, 78% vs 27% for psychological/emotional concern, 63% vs 22% for impaired sleep, 69% vs 29% for weight loss/gain, 59% vs 16% for sexual and intimacy concerns). GPs reported inadequate information transfer from cancer services and workload as major barriers to optimal care. Conclusions: System-level changes that facilitate adequate information transfer from cancer services to GPs upon CRC treatment completion, as well as addressing time constraint issues essential for comprehensive monitoring and management of CRC treatment sequelae, could enhance the care of CRC survivors in the community setting. Many colorectal cancer survivors face various post-treatment challenges that impact their daily lives. How these are treated within the primary care setting remains poorly understood. This study found that colorectal cancer survivors commonly experienced various challenges after cancer treatment, such as fatigue, changed bowel habits and psychological difficulties, but often did not discuss them with their general practitioners. Potential ways to better identify and address these common post-treatment challenges for colorectal cancer survivors are needed. [ABSTRACT FROM AUTHOR]

Background. Chemotherapy can cause a range of side effects including nausea, vomiting, diarrhea, and infection, which can have a significant impact on an individual's quality of life. Survival outcomes can be impacted when side effects are poorly managed, leading to failure to complete the defined dose of treatment. Objective. This study presents clinicians' experiences with a shared care model involving home-based community nurse (CN) support to improve side-effect management of individuals receiving chemotherapy as an outpatient. Methods. A qualitative study was conducted with CNs, cancer nurses, medical oncologists, and a general practitioner involved in the CN intervention delivered as part of a randomized controlled trial (RCT) aimed at reducing unplanned presentations to hospital of cancer patients receiving outpatient chemotherapy. Semistructured individual and focus group interviews were conducted. Key themes were identified using thematic analysis. Findings. Twenty-three healthcare professionals were interviewed. Three themes were identified: (1) being able to enhance patient-centered care and clinical practice during chemotherapy; (2) importance of effective communication and collaborative relationships between different care settings; and (3) ways to adapt the intervention for implementation in routine clinical practice. Participants reported that it was feasible for CNs to care for this patient group, and their home visits enabled preemptive symptom management. Suggestions to improve and modify the intervention to implement this care model within existing clinical care included a flexible approach, such as a blended delivery with face-to-face visits and telephone calls; a risk- or needs-based approach to prioritize patient groups more likely to benefit from the intervention; and sharing of electronic medical records for more effective collaboration and communication. Conclusions. A CN-delivered shared care model provided a feasible approach to the provision of individualized support for outpatients receiving chemotherapy. This study suggests ways to adapt this care model into existing clinical workflow and structures. This trial is registered with ACTRN12614001113640. [ABSTRACT FROM AUTHOR]

The article explores the potential of low-dose computed tomography (LDCT) as a screening tool for lung cancer, emphasizing its benefits in early detection. Topics discussed include the effectiveness of LDCT in reducing lung cancer-specific mortality, comparisons with other screening modalities, and the anticipated national screening program in Australia.

Purpose: The aim of this randomised controlled trial (RCT) was to explore whether a community nursing intervention for outpatients receiving systemic therapy reduced unplanned hospital presentations and improved physical and psychosocial health outcomes over the first three cycles of treatment compared to a control group receiving standard care. Methods: The number of and reasons for unplanned presentations were obtained for 170 intervention and 176 control group adult patients with solid tumours starting outpatient chemotherapy. Poisson regression was used to compare the number of presentations between the intervention and control groups. Patients self-completed the Hospital Anxiety and Depression Scale, the Cancer Behavior Inventory and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire core 30 (EORTC QLQ-C30) at the start of the first four cycles. Linear regression techniques were used to compare quality of life outcomes. Results: The reduction in unplanned presentations in the intervention group relative to the control group was 12% (95% CI, − 25%, 37%; P = 0.48). At the start of cycle 4, there was no difference in anxiety (difference = 0.47 (95% CI, − 0.28, 1.22; P = 0.22)), depression (difference = 0.57 (95% CI, − 0.18, 1.31; P = 0.13)) or EORTC QLQ-C30 summary score (difference = 0.16 (95% CI, − 2.67, 3.00; P = 0.91)). Scores for self-efficacy as measured by the Cancer Behavior Inventory were higher in the intervention group (difference = 4.3 (95% CI, 0.7, 7.9; P = 0.02)). Conclusion: This RCT did not demonstrate a benefit in reducing unplanned presentations to hospital. The trial identified improved cancer-based self-efficacy in patients receiving the intervention. Trial registration: Registered at Australian and New Zealand Clinical Trials Registry: ACTRN12614001113640, registered 21/10/2014. [ABSTRACT FROM AUTHOR]

A sample of current DTC telemedicine services in Australia sourced from an online health technology services directory, healthtech scout (www.healthtechscout.com.au), is listed in the Box. Keywords: Telemedicine; Primary care; Primary health care; Health services; Privatization; Prescribing EN Telemedicine Primary care Primary health care Health services Privatization Prescribing 344 347 4 10/17/23 20231002 NES 231002 The advent of the coronavirus disease 2019 (COVID-19) pandemic has heralded a new era of telehealth for the provision of primary health care in Australia. Inclusion criteria: i) service is operational at the time of access; ii) offers a telemedicine consultation with a medical practitioner in a primary care setting; iii) main fee structure does not involve Medicare rebates; and iv) wholly virtual service with no brick-and-mortar clinic. [Extracted from the article]

Background: Advances in screening and treatments for colorectal cancer (CRC) have improved survival rates, leading to a large population of CRC survivors. Treatment for CRC can cause long-term side-effects and functioning impairments. General practitioners (GPs) have a role in meeting survivorship care needs of this group of survivors. We explored CRC survivors' experiences of managing the consequences of treatment in the community and their perspective on the GP's role in post-treatment care. Methods: This was a qualitative study using an interpretive descriptive approach. Adult participants no longer actively receiving treatment for CRC were asked about: side-effects post-treatment; experiences of GP-coordinated care; perceived care gaps; and perceived GP role in post-treatment care. Thematic analysis was used for data analysis. Results: A total of 19 interviews were conducted. Participants experienced side-effects that significantly impacted their lives; many they felt ill-prepared for. Disappointment and frustration was expressed with the healthcare system when expectations about preparation for post-treatment effects were not met. The GP was considered vital in survivorship care. Participants' unmet needs led to self-management, self-directed information seeking and sourcing referral options, leaving them feeling like their own care coordinator. Disparities in post-treatment care between metropolitan and rural participants were observed. Conclusion: There is a need for improved discharge preparation and information for GPs, and earlier recognition of concerns following CRC treatment to ensure timely management and access to services in the community, supported by system-level initiatives and appropriate interventions. Colorectal cancer survivors can experience ongoing side-effects and functioning impairments long after completing treatment. This study explored how colorectal cancer survivors manage their consequences of treatment in the community. Colorectal cancer survivors were interviewed about the side-effects they experienced after treatment; their experiences of general practitioner-coordinated care; perceived care gaps; and their perception of the general practitioner role in post-treatment survivorship care. [ABSTRACT FROM AUTHOR]

Climate change is a global threat to ecosystems and the people that depend on them. However, the perceived threat of climate change may vary spatially. Previous research suggests that inhabitants in rural areas show higher levels of place attachment (associating meaning with a specific place) than urbanites, possibly because rural people depend more directly on their local environment. This can shape perceptions and behaviours, such as enhanced willingness to engage in landscape preservation. Here we ask if it also makes rural people perceive climate change as a greater threat, using a representative sample of 1,071 survey respondents from across the United Kingdom (UK) to provide first-order insights. We found that, whilst indicators of place attachment were indeed more frequent in rural areas, the perceived threat of climate change in the most rural locations was lower. We discuss possible explanations for this pattern (including lower levels of awareness of the anthropogenic causes of climate change, lessened first-hand experiences of climate change impacts due to higher levels of regulating ecosystem services, and higher levels of resilience in rural areas related to a closer relationship with nature), and call for further research to investigate this. [ABSTRACT FROM AUTHOR]

The article focuses on the implications of breast density in screening mammograms and its role in cancer detection. Topics include the impact of breast density on mammogram sensitivity, international guidelines on supplemental imaging, and evidence-based approaches for GPs in discussing breast cancer risk with patients.

Landscape decisions are multi‐faceted. Framing landscape decision‐making as a governance process that requires a collective approach can encourage key stakeholders to come together to co‐inform a discussion about their priorities and what constitutes good governance, leading to more holistic landscape decisions.In this paper, we recognise that a suite of complementary and multi‐dimensional approaches are in practice used to inform and evaluate land use decisions. We have called these approaches 'lenses' because they each provide a different perspective on the same problem. The four lenses are (i) power and market gain, (ii) ecosystem services, (iii) place‐based identity and (iv) ecocentric. Each brings a different set of evidence and viewpoints (narrative, qualitative and experiential, as well as quantitative metrics such as monetary) to the decision‐making process and can potentially reveal problems and solutions that others do not.Considering all lenses together allows dialogue to take place which can reveal the true complexities of landscape decision‐making and can facilitate more effective and more holistic decisions. Employing the lenses requires governance structures that give equal weight to all lenses, enable dialogue and coexistence between top down and bottom‐up approaches, and permit adaptation to local and granular place‐specifics rather than developing "one‐size‐fits‐all" solutions.We propose that formalising the process of balancing all the lenses requires public participation, and that a lens approach should be used to support landscape decisions alongside a checklist that facilitates transparency in the conversation, showing how all evidence has been considered and critically assessed. Read the free Plain Language Summary for this article on the Journal blog. Read the free Plain Language Summary for this article on the Journal blog. [ABSTRACT FROM AUTHOR]

Background and objective The aim of this study was to describe the pattern of mental health attendances in a university-based general practice clinic during phases of the COVID-19 pandemic. The COVID-19 pandemic has created social and medical disruptions to the Australian community. There is a literature gap pertaining to the ongoing trends that extend beyond the initial ‘first wave’ of the pandemic in the context of the Australian landscape. Methods Retrospective data were obtained from 435 adults attending a community university-based general practice in Sydney, Australia, during four time periods: T1, before the COVID-19 pandemic (1 February – 7 March 2019); T2, during the first COVID-19 lockdown (31 March – 4 May 2020); T3, during the second COVID-19 lockdown (20 August – 23 September 2021); and T4, after the end of the COVID-19 lockdowns (1 February – 7 March 2022). Attendances were identified as mental health Medicare Benefits Schedule codes for face-to-face, televideo and telephone consultations. Patterns of attendances were evaluated using frequency analysis. Results There was a decline in mental health attendances compared to all attendances at the general practice from T1 (7.5%) to T2 (4.8%). During T4, mental health attendances returned to 7.1% of all consultations at the general practice. Face-to-face attendances decreased by 50% in T2 relative to T1, and this trend was maintained in T3 and T4, whereas the utilisation of telehealth approached that of face-to-face by T4. Discussion Post-pandemic policies that support the use of telehealth in general practice may help improve mental healthcare delivery and outcomes. [ABSTRACT FROM AUTHOR]

The article focuses on the recent advances in the development of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and small interfering ribonucleic acid (siRNA) for the treatment of dyslipidemia. It provides a summary of the evidence supporting the use of these inhibitors and siRNA, along with relevant recommendations from consensus guidelines. It also discusses the mechanism of action of PCSK9 inhibitors and siRNA, and their potential impact on cardiac outcomes.

Background: Healthcare systems may be resilient and adaptive, but they are not fit for purpose in their current state. Increasing threats to health system sustainability have underscored the need to move towards a learning health system in which research and data are used routinely in clinical practice to facilitate system improvement. This study aimed to establish which elements of the learning health system were being realised within a university-based general practice and determine acceptability from staff to embrace further the transition towards a learning health system. Methods: Semi-structured interviews were conducted with practice staff, including clinical and administrative staff, to determine the current state of the learning health system in the practice. An embedded researcher was placed within the general practice on a part-time basis to investigate the learning health system model. Interviews were transcribed and thematically analysed based on the National Academy of Medicine's framework of learning health systems. Results: In total, 32 (91%) practice staff were interviewed, comprising general practitioners (n = 15), nurses (n = 3), administrative staff (n = 13), and a psychologist (n = 1). Participants indicated that the practice was operating with several characteristics of a learning health system (e.g., emphasising science and informatics; focusing on patient-clinician partnerships; applying incentives; supporting a continuous learning culture; and establishing structures and governance for learning). These measures were supported by the university-based setting, and resultant culture of learning. Nevertheless, there were areas of the practice where the learning health system could be strengthened, specifically relating to the use of patient data and informatics. Staff generally expressed willingness to engage with the process of strengthening the learning health system within their practice. Conclusion: Although the idea of a learning health system has been gaining traction in recent years, there are comparatively few empirical studies presented in the literature. This research presents a case study of a general practice that is operating as a learning health system and highlights the utility of using the learning health system framework. [ABSTRACT FROM AUTHOR]

Background: Low back pain is the largest cause of years lived with a disability in Australia, and there is an urgent need for innovations to address global gaps between evidence and practice. Methods: This study was a phase 1, single-group, pre–post pilot trial of My Back My Plan, a primary care program for acute low back pain. The trial was conducted at MQ Health Primary Care at Macquarie University in Sydney, Australia. The primary outcomes were feasibility and acceptability. Results: Fourteen participants were recruited to the study, with 79% and 93% followed up at 1 and 3 months respectively. Ten general practitioners and four physiotherapists at MQ Health Primary Care delivered the intervention. Although the rate of patient recruitment to the trial was low, other aspects of feasibility (such as intervention adherence and safety) were high. Participating clinicians reported that the program was useful for patients, and the majority stated that the program facilitated person-centred care. Patients rated My Back My Plan as highly acceptable, indicating that they had a better understanding of their low back pain, they were given personalised care and were more confident in self-managing their low back pain. At the 3 month follow-up, 85% of participants stated they were very likely to recommend the program to others. Conclusions: This study suggests that the co-designed, contextually refined MBMP program for MQ Health Primary Care is acceptable to people with acute onset low back pain and warrants further evaluation. Low back pain is the largest cause of years lived with a disability in Australia, and there is an urgent need for innovations to address global gaps between evidence and practice. Our study evaluated the feasibility and acceptability of My Back My Plan, a primary care program for acute low back pain. My Back My Plan facilitates delivery of person-centred care and was rated as highly acceptable to people with acute onset low back pain, and thereby warrants further evaluation. [ABSTRACT FROM AUTHOR]

Background: Low back pain is the leading worldwide cause of years lost to disability and the problem is worsening. This paper describes and demonstrates the scholarly development and contextual refinement of a primary care program for acute low back pain in Sydney, Australia. Methods: Hybrid theoretical frameworks were applied, and co-design was used to contextualise the program to the local healthcare setting. Results: The program was developed in four stages. In stage 1, the scientific evidence about management of acute low back pain in primary care was examined. In stage 2, stakeholders (patients and clinicians) were consulted in nationwide surveys. Data from stages 1 and 2 were used to design an initial version of the program, called My Back My Plan. Stage 3 involved the contextual refinement of the program to the local setting, MQ Health Primary Care. This was achieved by co-design with primary care clinicians and patients who had sought care for low back pain at MQ Health Primary Care clinics. In stage 4, a panel of Australian experts on clinical care for low back pain reviewed the contextualised version of My Back My Plan and final amendments were made. Conclusion: My Back My Plan has been developed using an innovative scholarly approach to intervention development. Low back pain is the leading worldwide cause of years lost to disability and the problem is worsening. Our study aimed to develop and test a low-cost, high-value, scalable primary care treatment program for acute low back pain. The 'My Back My Plan' program has been developed using an innovative scholarly approach to intervention development, including co-design with consumers and clinicians, and optimises provision of integrated clinical care that is individualised and person-centred. [ABSTRACT FROM AUTHOR]

The article focuses on population screening of low-risk asymptomatic men for prostate cancer with Prostate-specific antigen (PSA) testing and the use of multiparametric magnetic resonance imaging (MRI) in the diagnosis of prostate cancer. The article highlights recent 16-year follow-up data from the European Randomized study of Screening for Prostate Cancer (ERSPC), developments in the diagnosis of prostate cancer with multiparametric MRI to facilitate the shared decision-making process.

Background: Owing to the COVID-19 pandemic, the use of telehealth has expanded rapidly. However, little is known about the impact of delivering care through telehealth on communication between clinicians and patients. At an interactional level, the ways in which clinicians establish rapport and connection with their patients in telehealth consultations is not well understood. Aim: This study will explore interactional practices of GPs and patients in telehealth consultations to develop evidence-based resources to improve communication. Design & setting: The study will be conducted within the Australian general practice setting. Method: Conversation analysis and sociolinguistic discourse analysis of recorded telehealth consultations will provide direct evidence of specific elements contributing to successful and less successful instances of telehealth communication. This analysis will be complemented by co-design techniques such as qualitative and reflective interviews, and collaborative workshops with telehealth users including both GPs and patients. Conclusion: Effective communication is critical for telehealth consultations and is central to achieving optimal clinical outcomes and patient satisfaction. Evidence-based guidelines encompassing effective telehealth communication strategies will be co-developed with end-users in this study. [ABSTRACT FROM AUTHOR]

The article presents the discussion on assessments of ecosystem services based on maps of land cover. Topics include focusing on food production in Germany evidencing the arable crop patterns being partially determined by the local site; livestock grazing land due to the expansion of land for agriculture and wildlife conservation; and highlighting the cultural importance of livelihoods.

The article examines Hypertension remains an important modifiable cardiovascular risk factor that can be difficult to reliably diagnose. Topics include considered using office blood pressure (OBP) alone can result in incorrect diagnoses, while home blood pressure monitoring (HBPM) is time consuming for the patient and Ambulatory blood pressure monitoring (ABPM) is the reference standard for diagnosing blood pressure abnormalities and should be used when possible.

Objective: The study sought to understand the potential roles of a future artificial intelligence (AI) documentation assistant in primary care consultations and to identify implications for doctors, patients, healthcare system, and technology design from the perspective of general practitioners.Materials and Methods: Co-design workshops with general practitioners were conducted. The workshops focused on (1) understanding the current consultation context and identifying existing problems, (2) ideating future solutions to these problems, and (3) discussing future roles for AI in primary care. The workshop activities included affinity diagramming, brainwriting, and video prototyping methods. The workshops were audio-recorded and transcribed verbatim. Inductive thematic analysis of the transcripts of conversations was performed.Results: Two researchers facilitated 3 co-design workshops with 16 general practitioners. Three main themes emerged: professional autonomy, human-AI collaboration, and new models of care. Major implications identified within these themes included (1) concerns with medico-legal aspects arising from constant recording and accessibility of full consultation records, (2) future consultations taking place out of the exam rooms in a distributed system involving empowered patients, (3) human conversation and empathy remaining the core tasks of doctors in any future AI-enabled consultations, and (4) questioning the current focus of AI initiatives on improved efficiency as opposed to patient care.Conclusions: AI documentation assistants will likely to be integral to the future primary care consultations. However, these technologies will still need to be supervised by a human until strong evidence for reliable autonomous performance is available. Therefore, different human-AI collaboration models will need to be designed and evaluated to ensure patient safety, quality of care, doctor safety, and doctor autonomy. [ABSTRACT FROM AUTHOR]

Low back pain (LBP) is the highest cause of years lived with a disability in Australia and the most frequent musculoskeletal condition for which patients seek primary care. The aims of this study were to: (1) evaluate the current practices and perspectives of Australian GPs and physiotherapists managing acute back pain; and (2) explore alignment of care with clinical guidelines. This was a prospective cross-sectional Internet survey conducted from March 2018 to May 2018 of experienced Australian GPs and physiotherapists. Descriptive statistics were used to analyse all quantitative outcomes. Two hundred primary care practitioners (72% physiotherapists and 28% GPs) from all States and Territories of Australia completed the survey. Most primary care practitioners were familiar with clinical guidelines for acute back pain management and reported delivery of many of the core components of guideline-based care, including education, advice about favourable prognosis, encouraging activity and self-management and discouraging prolonged bed rest. Deviations from guideline-based care were common, including provision of analgesic medication, passive therapies and using radiological imaging. Australian primary care clinicians in this sample were aware of back pain guidelines and typically implement care that is consistent with guideline-based recommendations. Divergences from these guidelines may indicate that primary care practitioners are delivering evidence-based and person-centred care that integrates clinicians' judgement with patients' preferences and guideline-based evidence. Low back pain (LBP) is the most burdensome condition globally and experts have recently advocated for clinicians to deliver high-value care based on clinical guidelines. However, the current practices and perspectives of primary care practitioners delivering care for acute LBP in Australia are unknown. This study found that when managing acute back pain, most GPs and physiotherapists included key components of guideline-based care, although a person-centred approach often required alternative management strategies. [ABSTRACT FROM AUTHOR]

Regime shifts can abruptly affect hydrological, climatic and terrestrial systems, leading to degraded ecosystems and impoverished societies. While the frequency of regime shifts is predicted to increase, the fundamental relationships between the spatial-temporal scales of shifts and their underlying mechanisms are poorly understood. Here we analyse empirical data from terrestrial (n = 4), marine (n = 25) and freshwater (n = 13) environments and show positive sub-linear empirical relationships between the size and shift duration of systems. Each additional unit area of an ecosystem provides an increasingly smaller unit of time taken for that system to collapse, meaning that large systems tend to shift more slowly than small systems but disproportionately faster. We substantiate these findings with five computational models that reveal the importance of system structure in controlling shift duration. The findings imply that shifts in Earth ecosystems occur over 'human' timescales of years and decades, meaning the collapse of large vulnerable ecosystems, such as the Amazon rainforest and Caribbean coral reefs, may take only a few decades once triggered. Little is known about how the speed of ecosystem collapse depends on ecosystem size. Here, Cooper, Willcock et al. analyse empirical data and models finding that although regime shift duration increases with ecosystem size, this relationship saturates and even large ecosystems can collapse in a few decades. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the prevalence of psychiatric morbidity, alcohol use, burnout and compassion satisfaction among physician trainees in New South Wales, Australia, and examine links between personal, demographic and lifestyle factors. Methods: A total of 67 physician trainees were recruited to the study. Fifty-nine completed the online survey (88% response rate). Outcome measures included the Depression Anxiety Stress Scale, Professional Quality of Life Scale and Alcohol Use Disorders Identification Test. Results: Approximately half the respondents met screening criteria for depression (53%), stress (51%) and anxiety (46%). Secondary traumatic stress was exceptionally high across the cohort, with higher scores in females (P = 0.001). The main reasons for not seeking help for depression or anxiety were lack of time (81%), fear of lack of confidentiality or privacy (41%), embarrassment (39%) and effect on registration (27%). Eighty-eight per cent of respondents agreed that doctors feel they need to portray a healthy image, but only 54% engaged in regular exercise and 24% slept ≤6 h each day. Conclusion: The results demonstrate high levels of non-psychotic psychiatric morbidity among physician trainees and a need to improve their well-being. Workplace systems need to promote healthy work environments and support physician trainees through good mentorship and supervision. What is known about the topic?: Doctors' health and patient care can be affected when doctors experience burnout and psychiatric morbidity. What does this paper add?: This paper adds to the evidence of psychiatric morbidity, burnout, secondary trauma and increased demographic data on a cohort of junior doctors undertaking speciality training. In addition, it provides reasons for not seeking help and positive and negative coping methods used by these junior doctors. What are the implications for practitioners?: The level of distress is high and requires system changes to support both individual health measures and structural change to work and study programs. [ABSTRACT FROM AUTHOR]

Faced with environmental degradation, governments worldwide are developing policies to safeguard ecosystem services (ES). Many ES models exist to support these policies, but they are generally poorly validated, especially at large scales, which undermines their credibility. To address this gap, we describe a study of multiple models of five ES, which we validate at an unprecedented scale against 1675 data points across sub-Saharan Africa. We find that potential ES (biophysical supply of carbon and water) are reasonably well predicted by the existing models. These potential ES models can also be used as inputs to new models for realised ES (use of charcoal, firewood, grazing resources and water), by adding information on human population density. We find that increasing model complexity can improve estimates of both potential and realised ES, suggesting that developing more detailed models of ES will be beneficial. Furthermore, in 85% of cases, human population density alone was as good or a better predictor of realised ES than ES models, suggesting that it is demand, rather than supply that is predominantly determining current patterns of ES use. Our study demonstrates the feasibility of ES model validation, even in data-deficient locations such as sub-Saharan Africa. Our work also shows the clear need for more work on the demand side of ES models, and the importance of model validation in providing a stronger base to support policies which seek to achieve sustainable development in support of human well-being. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to characterize the dynamic structure of primary care consultations by identifying typical activities and their inter-relationships to inform the design of automated approaches to clinical documentation using natural language processing and summarization methods.Materials and Methods: This is an observational study in Australian general practice involving 31 consultations with 4 primary care physicians. Consultations were audio-recorded, and computer interactions were recorded using screen capture. Physical interactions in consultation rooms were noted by observers. Brief interviews were conducted after consultations. Conversational transcripts were analyzed to identify different activities and their speech content as well as verbal cues signaling activity transitions. An activity transition analysis was then undertaken to generate a network of activities and transitions.Results: Observed activity classes followed those described in well-known primary care consultation models. Activities were often fragmented across consultations, did not flow necessarily in a defined order, and the flow between activities was nonlinear. Modeling activities as a network revealed that discussing a patient's present complaint was the most central activity and was highly connected to medical history taking, physical examination, and assessment, forming a highly interrelated bundle. Family history, allergy, and investigation discussions were less connected suggesting less dependency on other activities. Clear verbal signs were often identifiable at transitions between activities.Discussion: Primary care consultations do not appear to follow a classic linear model of defined information seeking activities; rather, they are fragmented, highly interdependent, and can be reactively triggered.Conclusion: The nonlinearity of activities has significant implications for the design of automated information capture. Whereas dictation systems generate literal translation of speech into text, speech-based clinical summary systems will need to link disparate information fragments, merge their content, and abstract coherent information summaries. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of a workshop intervention to promote wellbeing for Australian physician trainees using a randomized-controlled design.Methods: Participants were randomly assigned into intervention and control groups. The intervention group attended a half-day workshop. Outcome measures included depression anxiety stress scale, professional quality of life scale and alcohol use disorders identification test. Demographic and work/life factors were measured. Measurements were recorded at baseline, 3 and 6 months, and the workshop was evaluated by participants.Results: High rates of burnout (76%) and secondary traumatic stress (91%) were detected among study participants and around half met screening criteria for depression (52%), anxiety (46%) and stress (50%) at baseline. Workshop evaluations showed that participants agreed that the training was relevant to their needs (96%) and met their expectations (92%). There was a small reduction in alcohol use, depression and burnout in the intervention group compared with the control group at 6 months, but these changes did not reach statistical significance.Conclusion: High rates of psychological morbidity detected in the study suggest that physician trainees are a vulnerable group who may benefit from initiatives that promote wellbeing and changes in the workplace to reduce distress. [ABSTRACT FROM AUTHOR]

Conversion of forest to oil palm plantations results in a significant loss of biodiversity. Despite this, first‐cycle oil palm plantations can sustain relatively high biodiversity compared to other crops. However, the long‐term effects of oil palm agriculture on flora and fauna are unknown. Oil palm has a 25‐year commercial lifespan before it must be replanted, due to reduced productivity and difficulty of harvesting. Loss of the complex vegetation structure of oil palm plantations during the replanting process will likely have impacts on the ecosystem at a local and landscape scale. However, the effect of replanting on biodiversity is poorly understood.Here, we investigate the effects of replanting oil palm on soil macrofauna communities. We assessed ordinal richness, abundance, and community composition of soil macrofauna in first‐ (25‐ to 27‐year‐old) and second‐cycle oil palm (freshly cleared, 1‐year‐old, 3‐year‐old, and 7‐year‐old mature).Macrofauna abundance and richness drastically declined immediately after replanting. Macrofauna richness showed some recovery 7 years after replanting, but was still 19% lower than first‐cycle oil palm. Macrofauna abundance recovered to similar levels to that of first‐cycle oil palm plantations, 1 year after replanting. This was mainly due to high ant abundance, possibly due to the increased understory vegetation as herbicides are not used at this age. However, there were subsequent declines in macrofauna abundance 3 and 7 years after replanting, resulting in a 59% drop in macrofauna abundance compared to first‐cycle levels. Furthermore, soil macrofauna community composition in all ages of second‐cycle oil palm was different to first‐cycle plantations, with decomposers suffering particular declines.After considerable biodiversity loss due to forest conversion for oil palm, belowground invertebrate communities suffer a second wave of biodiversity loss due to replanting. This is likely to have serious implications for soil invertebrate diversity and agricultural sustainability in oil palm landscapes, due to the vital ecosystem functions that soil macrofauna provide. [ABSTRACT FROM AUTHOR]

Current approaches for assessing the effects of invasive alien species (IAS) are biased toward the negative effects of these species, resulting in an incomplete picture of their real effects. This can result in an inefficient IAS management. We address this issue by describing the INvasive Species Effects Assessment Tool (INSEAT) that enables expert elicitation for rapidly assessing the ecological consequences of IAS using the ecosystem services (ES) framework. INSEAT scores the ecosystem service "gains and losses" using a scale that accounted for the magnitude and the reversibility of its effects. We tested INSEAT on 18 IAS in Great Britain. Here, we highlighted four case studies: Harmonia axyridis (Harlequin ladybird), Astacus leptodactylus (Turkish crayfish), Pacifastacus leniusculus (Signal crayfish) and Impatiens glandulifera (Himalayan balsam). The results demonstrated that a collation of different experts' opinions using INSEAT could yield valuable information on the invasive aliens' ecological and social effects. The users can identify certain IAS as ES providers and the trade‐offs between the ES provision and loss associated with them. This practical tool can be useful for evidence‐based policy and management decisions that consider the potential role of invasive species in delivering human well‐being. [ABSTRACT FROM AUTHOR]

Rewilding as a conservation strategy is gaining increasing scientific, political and public attention, yet empirical evaluations of its impacts remain scarce, especially with regards to ecosystem services. We provide evidence of the change in three ecosystem services (timber [provisioning], pollination [regulating], and aesthetics [cultural]) from up to 27 years of a moorland rewilding strategy in the Scottish Highlands using a chronosequence of rewilded plots and adjacent controls. These services were assessed in the field and using online surveys. We found that rewilding increased aboveground woody biomass and restored natural tree recruitment processes, although the latter only emerged after at least 15 years of rewilding. Rewilding caused a linear increase in perceived aesthetic quality over the first 27 years, but had no effect on pollination visitation rates. Thus, we conclude that rewilding can be used for ecosystem service recovery in moorland landscapes, but that results vary depending on the preferred service. EDITED BY John Haslett [ABSTRACT FROM AUTHOR]

However, there is a scarcity of literature at the micro-level where the "rubber hits the road" - where GP-led, multi-stakeholder teams operate, and patients interact with, general practice clinics and their staff. A perfect storm of an ageing general practice workforce,[1] SP , sp [2] a declining interest in general practice as a career,[1] and widespread burnout exacerbated by the COVID-19 pandemic[3] leaves general practice in a precarious position worldwide. [Extracted from the article]

The article offers information that Allopurinol, a xanthine oxidase inhibitor, reduces the conversion of hypoxanthine and xanthine to uric acid, and it constitutes up to 98 percent of the urate-lowering medications prescribed in Australia. It also discusses that e severe cutaneous adverse reactions includes Stevens–Johnson Syndrome, toxic epidermal necrolysis and drug reaction with eosinophilia and systemic symptoms.

Land cover has changed rapidly across the tropics over the past century; however, detailed historical information describing the extent and possible drivers of such change is widely lacking. Here, we constructed a history of land-cover change at the district level in Malawi over a 37-year period from 1972 to 2009, the immediate post-colonial phase. Overall, there was a loss of 12 760 km2 (36%) of original forested area but also 11 161 km2 of new forest establishment, resulting in a relatively modest overall net loss of 1 599 km2 (5%). We correlated changes in deforestation and forest establishment with changes in socio-economic variables derived from spatially explicit data from the same time period. Deforestation was positively correlated with (in order of influence) changes in male school attendance, sex ratio, population density, hospital bed numbers, protected areas and dependency rate, but negatively correlated with changes in cattle density; forest establishment broadly showed the inverse relationships with the same variables. Although direct drivers of deforestation are well known for Malawi and much of Africa, the significance of socio-economic variables within this study can help to understand the underlying social pressures behind such drivers. In particular, development, population pressure and demographic factors are important predictors of deforestation rate within our study area. [ABSTRACT FROM AUTHOR]

Background: Problems may arise during the approval process of treatment after a compensable work injury, which include excess paperwork, delays in approving services, disputes, and allegations of over-servicing. This is perceived as undesirable for injured people, health care professionals and claims managers, and costly to the health care system, compensation system, workplaces and society. Introducing an Evidence Based Medicine (EBM) decision tool in the workers' compensation system could provide a partial solution, by reducing uncertainty about effective treatment. The aim of this study was to investigate attitudes of health care professionals (HCP) to the potential implementation of an EBM tool in the workers' compensation setting.Methods: The study has a mixed methods design. The quantitative study consisted of an online questionnaire asking about self-reported knowledge, attitudes and behaviour to EBM in general. The qualitative study consisted of interviews about an EBM tool being applied in the workers' compensation process. Participants were health care practitioners from different clinical specialties. They were recruited through the investigators' clinical networks and the workers' compensation government regulator's website.Results: Participants completing the questionnaire (n = 231) indicated they were knowledgeable about the evidence-base in their field, but perceived some difficulties when applying EBM. General practitioners reported having the greatest obstacles to applying EBM. Participants who were interviewed (n = 15) perceived that an EBM tool in the workers' compensation setting could potentially have some advantages, such as reducing inappropriate treatment, or over-servicing, and providing guidance for clinicians. However, participants expressed substantial concerns that the EBM tool would not adequately reflect the impact of psychosocial factors on recovery. They also highlighted a lack of timeliness in decision making and proper assessment, particularly in pain management.Conclusions: Overall, HCP are supportive of EBM, but have strong concerns about implementation of EBM based decision making in the workers' compensation setting. The participants felt that an EBM tool should not be applied rigidly and should take into account clinical judgement and patient variability and preferences. In general, the treatment approval process in the workers' compensation insurance system is a sensitive area, in which the interaction between HCP and claims managers can be improved. [ABSTRACT FROM AUTHOR]

Miombo woodlands supply ecosystem services to support livelihoods in southern Africa, however, rapid deforestation has necessitated greater knowledge of tree growth and off-take rates to understand the sustainability of miombo exploitation. We established 48 tree inventory plots within four villages in southern Malawi, interviewed representatives in these same villages about tree management practices and investigated the impact of climate on vegetation dynamics in the region using the ecosystem modelling framework LPJ-GUESS. Combining our data with the forest yield model MYRLIN revealed considerable variation in growth rates across different land uses; forested lands showed the highest growth rates (1639 [95% confidence interval 1594–1684] kg ha–1 year–1), followed by settlement areas (1453 [95% confidence interval 1376–1530] kg ha–1 year–1). Based on the modelled MYRLIN results, we found that 50% of the villages had insufficient growth rates to meet estimated off-take. Furthermore, the results from LPJ-GUESS indicated that sustainable off-take approaches zero in drought years. Local people have recognized the unsustainable use of natural resources and have begun planting activities in order to ensure that ecosystem services derived from miombo woodlands are available for future generations. Future models should incorporate the impacts of human disturbance and climatic variation on vegetation dynamics; such models should be used to support the development and implementation of sustainable forest management. [ABSTRACT FROM PUBLISHER]

The article presents the discussion on multiple guidelines by cardiovascular societies around the world having advised about testing for non-fasting lipids. Topics include avoiding unnecessary testing of fasting lipids reducing the risk of symptomatic hypoglycaemia in individuals with diabetes; and non-fasting lipids warranting a subsequent fasting sample for calculation of LDL-C and triglyceride levels.

Agricultural expansion has resulted in both land use and land cover change (LULCC) across the tropics. However, the spatial and temporal patterns of such change and their resulting impacts are poorly understood, particularly for the presatellite era. Here, we quantify the LULCC history across the 33.9 million ha watershed of Tanzania's Eastern Arc Mountains, using geo-referenced and digitized historical land cover maps (dated 1908, 1923, 1949 and 2000). Our time series from this biodiversity hotspot shows that forest and savanna area both declined, by 74% (2.8 million ha) and 10% (2.9 million ha), respectively, between 1908 and 2000. This vegetation was replaced by a fivefold increase in cropland, from 1.2 million ha to 6.7 million ha. This LULCC implies a committed release of 0.9 Pg C (95% CI: 0.4-1.5) across the watershed for the same period, equivalent to 0.3 Mg C ha-1 yr-1. This is at least threefold higher than previous estimates from global models for the same study area. We then used the LULCC data from before and after protected area creation, as well as from areas where no protection was established, to analyse the effectiveness of legal protection on land cover change despite the underlying spatial variation in protected areas. We found that, between 1949 and 2000, forest expanded within legally protected areas, resulting in carbon uptake of 4.8 (3.8-5.7) Mg C ha-1, compared to a committed loss of 11.9 (7.2-16.6) Mg C ha-1 within areas lacking such protection. Furthermore, for nine protected areas where LULCC data are available prior to and following establishment, we show that protection reduces deforestation rates by 150% relative to unprotected portions of the watershed. Our results highlight that considerable LULCC occurred prior to the satellite era, thus other data sources are required to better understand long-term land cover trends in the tropics. [ABSTRACT FROM AUTHOR]

BackgroundAppropriate communication between general practitioners (GPs) and physiotherapists is vital for providing optimal care. Differing opinions exist as to key inclusion in this communication. This study aims to identify the key components that both GPs and physiotherapists would include in inter-professional communication.MethodsQualitative study design, using 14 in-depth, semi-structured telephone interviews.ResultsPhysiotherapists identified relevant past medical history, psycho-social history, yellow flags, anticipated time frame for follow-up and objective measures of current function as the more useful inclusions in written communication. GPs identified the inclusion of a working diagnosis, treatment summary and likely long-term outcomes as the key components to effective communication.DiscussionEffective interprofessional communication requires the provision of information that is both succinct and relevant. While there are individual preferences, this study suggests that certain key characteristics exist, and the inclusion of these in interprofessional communication may lead to improved communication and patient outcomes. [ABSTRACT FROM AUTHOR]

Background: This debate discusses the potential merits of a New Graduate Nurse Transition to Primary Health Care Program as an untested but potential nursing workforce development and sustainability strategy. Increasingly in Australia, health policy is focusing on the role of general practice and multidisciplinary teams in meeting the service needs of ageing populations in the community. Primary health care nurses who work in general practice are integral members of the multidisciplinary team -- but this workforce is ageing and predicted to face increasing shortages in the future. At the same time, Australia is currently experiencing a surplus of and a corresponding lack of employment opportunities for new graduate nurses. This situation is likely to compound workforce shortages in the future. A national nursing workforce plan that addresses supply and demand issues of primary health care nurses is required. Innovative solutions are required to support and retain the current primary health care nursing workforce, whilst building a skilled and sustainable workforce for the future. Discussion: This debate article discusses the primary health care nursing workforce dilemma currently facing policy makers in Australia and presents an argument for the potential value of a New Graduate Transition to Primary Health Care Program as a workforce development and sustainability strategy. An exploration of factors that may contribute or hinder transition program for new graduates in primary health care implementation is considered. Summary: A graduate transition program to primary health care may play an important role in addressing primary health care workforce shortages in the future. There are, however, a number of factors that need to be simultaneously addressed if a skilled and sustainable workforce for the future is to be realised. The development of a transition program to primary health care should be based on a number of core principles and be subjected to both a summative and cost-effectiveness evaluation involving all key stakeholders. [ABSTRACT FROM AUTHOR]

Background The carbon stored in vegetation varies across tropical landscapes due to a complex mix of climatic and edaphic variables, as well as direct human interventions such as deforestation and forest degradation. Mapping and monitoring this variation is essential if policy developments such as REDD+ (Reducing Emissions from Deforestation and Forest Degradation) are to be known to have succeeded or failed. Results We produce a map of carbon storage across the watershed of the Tanzanian Eastern Arc Mountains (33.9 million ha) using 1,611 forest inventory plots, and correlations with associated climate, soil and disturbance data. As expected, tropical forest stores more carbon per hectare (182 Mg C ha-1) than woody savanna (51 Mg C ha-1). However, woody savanna is the largest aggregate carbon store, with 0.49 Pg C over 9.6 million ha. We estimate the whole landscape stores 1.3 Pg C, significantly higher than most previous estimates for the region. The 95% Confidence Interval for this method (0.9 to 3.2 Pg C) is larger than simpler look-up table methods (1.5 to 1.6 Pg C), suggesting simpler methods may underestimate uncertainty. Using a small number of inventory plots with two censuses (n = 43) to assess changes in carbon storage, and applying the same mapping procedures, we found that carbon storage in the tree-dominated ecosystems has decreased, though not significantly, at a mean rate of 1.47 Mg C ha-1 yr-1 (c. 2% of the stocks of carbon per year). Conclusions The most influential variables on carbon storage in the region are anthropogenic, particularly historical logging, as noted by the largest coefficient of explanatory variable on the response variable. Of the non-anthropogenic factors, a negative correlation with air temperature and a positive correlation with water availability dominate, having smaller p-values than historical logging but also smaller influence. High carbon storage is typically found far from the commercial capital, in locations with a low monthly temperature range, without a strong dry season, and in areas that have not suffered from historical logging. The results imply that policy interventions could retain carbon stored in vegetation and likely successfully slow or reverse carbon emissions. [ABSTRACT FROM AUTHOR]

Background: The carbon stored in vegetation varies across tropical landscapes due to a complex mix of climatic and edaphic variables, as well as direct human interventions such as deforestation and forest degradation. Mapping and monitoring this variation is essential if policy developments such as REDD+ (Reducing Emissions from Deforestation and Forest Degradation) are to be known to have succeeded or failed. Results: We produce a map of carbon storage across the watershed of the Tanzanian Eastern Arc Mountains (33.9 million ha) using 1,611 forest inventory plots, and correlations with associated climate, soil and disturbance data. As expected, tropical forest stores more carbon per hectare (182 Mg C ha) than woody savanna (51 Mg C ha). However, woody savanna is the largest aggregate carbon store, with 0.49 Pg C over 9.6 million ha. We estimate the whole landscape stores 1.3 Pg C, significantly higher than most previous estimates for the region. The 95% Confidence Interval for this method (0.9 to 3.2 Pg C) is larger than simpler look-up table methods (1.5 to 1.6 Pg C), suggesting simpler methods may underestimate uncertainty. Using a small number of inventory plots with two censuses ( n = 43) to assess changes in carbon storage, and applying the same mapping procedures, we found that carbon storage in the tree-dominated ecosystems has decreased, though not significantly, at a mean rate of 1.47 Mg C ha yr (c. 2% of the stocks of carbon per year). Conclusions: The most influential variables on carbon storage in the region are anthropogenic, particularly historical logging, as noted by the largest coefficient of explanatory variable on the response variable. Of the non-anthropogenic factors, a negative correlation with air temperature and a positive correlation with water availability dominate, having smaller p-values than historical logging but also smaller influence. High carbon storage is typically found far from the commercial capital, in locations with a low monthly temperature range, without a strong dry season, and in areas that have not suffered from historical logging. The results imply that policy interventions could retain carbon stored in vegetation and likely successfully slow or reverse carbon emissions. [ABSTRACT FROM AUTHOR]

Background There is growing evidence that health and social outcomes following motor vehicle crash injury are related to cognitive and emotional responses of the injured individual, as well as relationships between the injured individual and the compensation systems with which they interact. As most of this evidence comes from other states in Australia or overseas, investigation is therefore warranted to identify the key determinants of health and social outcomes following injury in the context of the New South Wales motor accident insurance scheme. Methods/Design In this inception cohort study, 2400 participants, aged 17 years or more, injured in a motor vehicle crash in New South Wales will be identified though hospital emergency departments, general and physiotherapy practitioners, police records and a government insurance regulator database. Participants will be initially contacted through mail. Baseline interviews will be conducted by telephone within 28 days of the injury and participants will be followed up with interviews at 6, 12 and 24 months post-injury. Health insurance and pharmaceutical prescription data will also be collected. Discussion The study results will report short and long term health and social outcomes in the study sample. Identification of factors associated with health and social outcomes following injury, including related compensation factors will provide evidence for improved service delivery, post-injury management, and inform policy development and reforms. Trial registration Australia New Zealand Clinical trial registry identification number - ACTRN12613000889752. Available at: ANZCTR Registered FISH Study. [ABSTRACT FROM AUTHOR]